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An interview with Cathy Margolin, L.Ac. Dipl OM, Founder of Pacific Herbs
Did you know that your patients can request reimbursement for select Chinese Herbal Formulas?
Thanks to Cathy, the answer is now YES!
Question: Cathy, we are surprised to learn that you have pioneered a methodology for health providers to bill insurance companies for Chinese herbs. Can you tell us about this?
Answer: One of my long term goals in starting Pacific Herbs was to not only make Chinese herbs easy for Westerners to understand and use, but also to make them affordable. As most Acupuncturists know, Chinese herbs in granules and raw form are easily affordable throughout China, Taiwan and Japan because they are included in coverage by the National Health Insurance in each of those countries, respectively.
In the U.S., it seems that we are a long way away from having Chinese herbs covered by private or public insurance. Many patients cannot afford herbal formulas, especially if they need to take something long term.
I decided to explore other options and discovered you cannot get insurance reimbursement unless you can put an item (or an herbal product in this case), on a medical bill. To add anything to a medical bill one must use a billing code. The next logical question to me was, how do we get a code? Well, I learned the American Medical Association (AMA) owns all billing codes in the U.S. and one must apply for a code with the AMA.
Question: What happened when you applied for an AMA Billing Codes?
Answer: We applied and I discovered the process was not quite as simple as I was originally led to believe. But, we went ahead and started the process and several years later we received the two billing codes we applied for. One is a for Pacific Herbs Corydalis Pain Relief Herb Pack and the other for Pacific Herbs Menopause Relief Herb Pack.
Question: How do practitioners use these codes?
Answer: The way a practitioner would use these codes is pretty straight forward. If a patient comes to you with pain for example, and the health practitioner decides Pacific Herbs Corydalis Pain Relief Herb Pack is an appropriate prescription for their patient’s pain. The patient would pay upfront for the cost of the herbs and the practitioner adds the price and billing code to the patient’s superbill or electronic bill.
If the patient is submitting a superbill to his/her insurance company, then it is up to the patient to submit their bill and discuss reimbursement with their insurer.
If the bill is electronically submitted to an insurer then it is up to the biller to follow up and request reimbursement. Once reimbursement is received by the doctor’s office, the patient must be notified and reimbursed appropriately.
Question: How long does it typically take to receive reimbursement from insurance companies?
Answer: The time table for reimbursement as most L.Ac’s already know, is such a guessing game. It varies from patient to patient, and each insurance company’s schedule varies.
We are still establishing precedent with many insurers. This means generally we are teaching computers to talk to each other. When a computer system receives a new billing code that it has not seen before it may take some human intervention, but not in all cases. Some insurance companies will reimburse the full amount once the code is processed, some partial and some may not reimburse.
Question: If a patient does not have insurance, can these billing codes help L.Ac’s provide herbs to their patients?
Answer: We have learned through this process that many patients are using their HSA, Health Saving Accounts to pay for our herbs and this is a valid usage. Many patients now have an HSA and are not sure which medical expenses are eligible. However, because Pacific Herbs has AMA approved billing codes for these two products, when they are prescribed by a licensed health professional they are valid for HSA account usage. Patients will have nothing to fear if this account is ever audited because the billing codes validate our products. This is not the case for the over the counter supplements.
There are also accounts called FSA (Flexible Spending Accounts) offered through individual employer’s health insurance. To use money in one’s FSA account towards our herbal products, a “Letter of Medical Necessity” (LMN) must be provided to the patient, outlining the need and duration for our herbal supplements, along with the billing code. The patient can be assured the FSA claim for reimbursement will be valid!
Question: Is there anything else we should know about reimbursement or helping patients be able to afford their herbs?
Answer: Understandably, there is a lot of confusion on how and where to add these codes to a superbill or electronic bill. We have an easy three step instruction sheet explaining the process on our website at PacHerbs.com/Billingcodes. Practitioners can see and download the three step process there.
I believe helping your patients choose the best herbs or supplement to complement their treatment is paramount to helping each patient feel their very best. A very wise teacher once told me, “Acupuncture is extremely effective, but it is always better to combine with herbs”.
Whether an Acupuncturist is trained in herbs and herbal formulas or not, our products make it simple for both the provider and the patient to understand what has often been complicated simply because of the name of the product. ALL Pacific Herb formulations are based on classic formulas, but we name them accordingly to keep it simple for our Western market.
